'War on drugs' fuelling the hepatitis C epidemic among people who inject drugs

Drastic rethink of drug policy advocated to avert HCV 'time bomb'

Michael Carter

Published: 29 May 2013

The global war on drugs has had a
disastrous impact on the hepatitis C epidemic, a new report from the Global
Commission on Drug Policy shows. The
Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic is
backed by seven former world leaders and cites evidence showing that the
criminalisation of drug use is fuelling a hepatitis C “viral time bomb”. The
report is being launched ahead of the 23rd International Harm
Reduction Conference, which will be held in Vilnius, Lithuania starting on 10 June.

“The war on drugs is a war on common
sense,” said Ruth Dreifuss, former president of Switzerland. “The hepatitis C
epidemic, totally preventable and curable, is…proof that the drug policy status
quo has failed us all miserably.”

The report highlights how countries with
the most repressive drug policies have some of the worst hepatitis C virus
epidemics among people who inject drugs.

Hepatitis C virus (HCV) is a blood-borne virus,
meaning that it can be transmitted via injecting drug use. Of the 16 million
individuals who inject drugs around the world, an estimated 10 million have hepatitis C. Chronic infection can lead to serious liver disease and is
an increasingly important cause of illness and death among injecting drug
users.

HCV is both preventable and curable. But
the report argues that the ongoing war against drugs is fuelling new HCV
transmissions and causing needless illness and death among people who inject
drugs.

“It is a disgrace that barely a handful of
countries can actually show significant declines in new infections of hepatitis
C among people who inject drugs,” said Commissioner Michel Kazatchkine, who is
the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central
Asia. “Hepatitis C has to be one of the most grossly miscalculated diseases by
governments on the planet.” He express especial concern about the situation in
Eastern Europe and Central Asia.

In some settings with especially harsh
policies on drugs, such as Thailand and Russia, up to 90% of injecting drug
users have hepatitis C. There are especially high numbers of HCV
infections among people who inject drugs in China (1.6 million), the USA (1.5
million) and the Russian Federation (1.5 million).

Harm reduction services – access to clean
injecting equipment and opioid substitution therapy – can prevent HCV infections. However, the
report cites research from around the world showing that repressive drug laws
mean that drug users are being driven away from these public health services.

“Limited public funds continue to be wasted
on harmful and ineffective drug law enforcement efforts instead of being
invested in proven treatment and prevention strategies,” says the report.

The imprisonment of people who inject drugs
is also leading to the spread of the virus. Of the 158 countries reporting drug
use in prisons, only ten provide needle and syringe exchange to inmates and
only 41 have opioid substitution programmes. The report highlights the
situation in the US, where between 12 and 35% of people in prison have hepatitis C compared to a prevalence of between 1 and 2% in the general
population. Despite this, the rate of testing among prisoners is low, and health
authorities in the US do not recommend the provision of clean injecting
equipment to prisoners.

HCV is a potentially curable infection, and
more efficacious and tolerable combinations of antiviral drugs are doing well
in clinical trials. However, even in a setting such as Lithuania, where there
has been real progress in the provision of free HCV therapy, treatment is
reaching only 5% of those in need.

Scotland is highlighted as an example of
best practice. The report praises key achievements following from the launch of
the country’s National Hepatitis C Action Plan. These include increased access
to clean injecting equipment; increases in the number of people tested for the virus; increased awareness of HCV; a doubling of the number of people
receiving therapy and a “clear downward trend in the rate of new HCV
infections”.

The report recommends that governments
should reform existing drug policies, ending the criminalisation and mass
imprisonment of people who use drugs. It also suggests that resources should be
directed away from the “war on drugs” and into public health interventions that
maximise HCV prevention and care.

“Government must remove any legal or de facto restrictions on the provision
of sterile injection equipment and other harm reduction services,” says the
report. “Governments should ensure that people who use drugs are not excluded
from treatment programmes.”

The authors call for urgent action,
concluding “the ‘war on drugs’ has failed, and significant public harms can be
averted if action is taken now”.

Reference

Global Commission on Drug Policy The Negative Impact of the War on Drugs on Public Health: The
Hidden Hepatitis C Epidemic. 2013. (Visit http://www.globalcommissionondrugs.org to download the report.)

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